Update on the management of atherosclerotic renal artery disease

Typically involving the renal artery ostium or proximal segment of the renal artery, atherosclerosis is the major cause of renal artery stenosis. While commonly without direct clinical consequences, the presence of renal artery atherosclerosis is associated with atherosclerotic disease in other vascular beds and in some subjects may give rise to systemic hypertension, progressive renal dysfunction and/or heart failure. Aggressive blood pressure control, atherosclerotic risk factor modification and use of anti-platelet therapy are indicated once diagnosed. The role for concomitant renal artery revascularization remains unclear and the decision should be individualized depending on patient preferences, co-morbidities, institutional expertise, and carefully weighed risks and benefits. Ongoing trials including CORAL and ASTRAL will hopefully provide critical evidence for or against this additive invasive strategy.